Your Name: Claire East
Your location: Ontario, Canada - North East of Toronto
NOTE: I am an avid fan of Zombie and other Survival-Horror genre's. I view such material as FICTION. In other words I personally do not believe in a coming
'Z-Day'. What I have written here is from my own personal and professional point of view. It is a work of fiction. I do not recommend realistically considering or attempting any Survival, Tactical, or especially MEDICAL procedures or protocols contained herein. This article itself is intended for entertainment purposes only.

Plan Principle Highlights
- Dependent upon Gear and Training
- Don't count on technology
- Be prepared to do your job, even when your boss is dead
- Other people > Creatures, in danger factor.
- Assume a radical containment protocol is pending
- Knowledge will last longer than Fire-Power
- Never compromise personal ethics; the last thing you need is guilt.
- Psychological health is paramount; "You can handle anything if your mind is in the right place".
- Solutions to your problems may violate responsible medical practice, but preservation of life without suffering is paramount.
- Acknowledge that I will screw up and kill someone.


PHASE I.
My civil responsibilities require that I not abandon my post until my observations and assessments of the situation have reached a critical threshold, at which point I will deal with responsibilities and remove myself from the Hospital. A loose set of criteria and situations I want to avoid are defined as follows:

Signs to Leave
- My passage into and out of the Hospital become restricted in any way, shape or form outside of normal passage protocols.
- Any sign of Military involvement
- Violent ambulatory patients
- Outbreak

To Avoid
- Being held captive in the Hospital; Military personnel, quarantine, etc.
- Being caught in an outbreak amongst staff, patients and other persons on premises

When reports first being to come in, I'll do what I always do, which is to trust my gut and error on the side of caution. As I cannot leave my post I will make contact with family and friends and either discuss how to bring them to me immediately, or how to proof their locations until such a time as I can retrieve them (this may be months later). Ideally, I'll have them come to me as inconspicuously as possible.

As a Backpack-Camper, Rock-climber and Physician I will already have a wide range of potential survival gear and supplies in my Home. Before I/We seal the house all gear required to wait-out a long period of time and also to move on when the time comes ill be moved to the second floor, during the time a roof-top exit will be inspected and secured. The lower floors will be proofed and 'ransacked' to deter future looters.

PHASE II.
Proofing the House And Enduring the Mass Panic
I won't leave my house until the city is dead, so to speak. I figure I have a higher chance of being mortally wounded or becoming infected while people are looting, screaming, fleeing and fighting. I'll have abandoned hospital duty after tying up professional loose ends (i.e. patients in my care). The first and second phases of survival are not so much about avoiding the undead, but about avoiding the hysterical living and the attempts made by governing bodies and militias to regain control. If there was ever a time to divorce myself from society, the time will have come when martial law appears to have come into place.

House Proofing, Waste Management, and Resource Security
-Park my SUV and ATV in the backyard shed as securely as possible, covering all windows and concealing locking mechanisms.
- Disable the anti-theft alarms on both vehicles. Should someone or something get into the shed and jostle either vehicle I don't want the alarms going off
and attracting others to the premises or forcing me to make my presence known by having to reset them.
- Empty the gas tanks. An empty tank may prevent theft of the vehicles should someone break into the shed. Empty tanks may also prevent explosions
should ignition of any kind occur near the vehicles. The fuel supply will be kept in the house.
-Seal the windows and doors on the main floor and in the basement.
- Plug the door and window locks with epoxy. After locking all door locks, make them resistant mechanical bypass by plugging the mechanisms.
- Board the inside of the doors from top to bottom and brace the slats.
- Nail the storm windows shut.
- Board the windows from top to bottom and brace the slats.
- Secure opaque tarps over each window to eliminate visibility into the house through cracks in the slats.
- Secure industrial plastic over all doors and windows to contain heat, seal-out and contain smells (outside: Body rot, burning debris, etc.; inside: cooking,
human waste,cigarette smoke etc), and to keep out moisture should the glass panes be broken.
-Barricade doors and windows suitable for entry
- Use heavy and bulky furniture to reinforce doors and windows.
- Barricade inner doors. Should outer entrances be breached, inner doors may contain the break-in.
-Secure the roof exit
- Board the attic entrance and attic entries as well as top floor windows. When the time comes to leave the house we will leave via the roof. In the
meantime these exits will be secured as stringently as the lower floor. On the upper floor all rooms will be sealed save for the three bedrooms that face
the backyard and the upstairs bathroom.
-Disconnect the gas lines to prevent leakage and/or accidental ignition.
-Destroy the stairs. Trips to the first floor and basement to reach the cellar can be completed by lowering an individual from the upstairs banister.
-Bathroom Protocols
- I live outside the city in a more rural area and am on well-water and a septic tank. We will use the toilet on a limited-flushing routine for as long we can,
after which waste will need to be excreted into bio-hazard-tough collection bags using the camping commode. Waste bags will be moved down into the
cellar weekly once the use of bags becomes required, along with bagged garbage and other waste products.A large mound of kitty litter will seat the bags
so that if leakage occurs, it is absorbed.
- Human litter box. The upstairs tub will be filled with kitty litter for excretion should we run out of bags. The litter loads can be transferred to the cellar by
bags or buckets when the time comes.
-Bathing Protocols
- Bathing must be kept to a minimum. Human sanitation is pertinent to lower the risk of illness and will be limited to sponge bathing. The use of dental
mouthwash will have to replace water in oral hygiene. Hand, Face, Genital and Peri-anal bathing will have priority. Rain water will have to suffice for
laundry. Melted snow (if the weather permits) will also be used.

Canadian Winter
With the gas lines cut off and the fact that I live in a rural area of mid-north Ontario we can safely assume that cooler weather will be quite cold here. Should our time at home entail endurance through the winter a variety of measures will be considered.
A fire is not the ideal heating method during this time since we are taking painstaking measures to remain undetected. Gas-powered heaters will be used on the most frigid of days and nights so that we can conserve gas. Chemical heating packs are part of the medical cache, but these will be only be used in the event a member of the group becomes alarmingly chilled.
As a family of campers we have more than one -45C sleeping bag in the house. All blankets, sheets, extra tarps, plastic, newspaper, pillows,
space blankets' and clothing will be used to form a group 'bed' on the mattresses that will be moved into the middle-most bedroom on the second floor.
Since winter usually brings cold and flu viruses, everyone present will have to wear surgical masks to guard against potential spread. Should anyone become ill they will be kept in the room to preserve warmth, but moved into a small dome-tent set up on the other side. The tent allows me to remove them from the others while still keeping them close and offers some form of barrier protection while attempting to contain the illness. By having them close to us, yet cordoned off, it may help to stagnate any anxiety they may feel about not only being ill, but being away from everyone else, which will contribute to the healing process if it can be negated. In a high-stress and limited sanitation environment, pathogens I would not normally be concerned about become paramount.

Food and Water
All food in the house and any that has been acquired prior to sealing the house will be brought upstairs and kept under lock and key supervision just like the medical supplies. Food, like medication, can be rationed and administered using a ‘dosage’ plan of action. Nutrients will be administered according to requirement, not desire.
Being a Canadian in snow country my home pantry is already stocked to sustain myself and a small number of others for roughly five months, unrestricted. Bulk cans of freeze-dried fruit, vegetables, eggs, cream of wheat, potato flakes, butter, cheese and milk are stocked next to a healthy supply of canned goods, Bottled & Jugged water, cereal, grain and other items with a long shelf-life. Food is not so much of a concern as water, though the well may stand to help alleviate this conundrum.
During the winter extra portions of foods that are high in fat and calorie content will ideally help to keep the group strong, healthy, and at an acceptable weight.
Use of artificial vitamin and protein supplements (also in the pantry) should help to address and nutritional gaps in the food provided.

Psychological Health
Cabin fever and the effects of isolation are exacerbating issues even without the global crisis and the shock and grief that will accompany it. The psychiatric health of myself (especially) and those I am with is a crucial concern on par with that of physical health.
When it is not winter the use of multiple rooms provides for some personal space between individuals. The use of ‘tent-forts’ to cover individual sleeping areas and strategic spacing of cots, mattresses and beds may help to keep fighting, paranoia, and irritability to lower level.
The smaller bedroom constitutes my office and doubles for sick/quiet room. Individuals who are ill, or become sufficiently overwhelmed to indicate intervention can be kept in the small bedroom where they will have privacy.
This room also permits me to deal with the health concerns of the group in a private atmosphere where both physical care and psychiatric care can coincide without interruption. This room also permits me to isolate any individuals who become unruly for reasons of panic, break-down, violence, or palliative state.
Entertainment will be a critical concern, especially since the use of battery-operated or electrical devices must be kept to a minimum. For as long as the power is on we will use it and the use of television, DVD movies, computers, and other devices will be permitted.
Books, board games, cards, puzzle-books, crafts and other entertainment items will have to suffice when the power goes out, or the power needs to be conserved.
Candles, bulbs, and other consumable light-sources will be rationed.
Psychotropic medications may be necessary in the management of hysterical individuals or deeply distressed group members. A large supply of Lorazepam and other sedative-anxiolytic medication would be ideal for managing these situations.

Physical Health
Stress and limited-sanitary conditions will make health a major concern. Prevention will have to be our primary method of coping since advanced medical care is not an option, and medication and other supplies are limited. Frequent self and assisted-check-ups will be necessary to maintain a tight lid on illness and injury.
A member of my family is diabetic. This is a critical concern that may plague others in other places. Insulin is not something can be easily stocked in bulk and maintained since it does expire. A single bar fridge will be powered by a gas-generator should the power go out. All insulin and other medical supplies that require refrigeration will need to be kept inside.
An alternative method of managing blood sugar will have to be devised with the assumption that synthetic or animal insulin will no longer be an option. I’m not sure what I might do about this.

Difficult Problems with No Simple Moral Solution
- What if an Infant/Child with me cries
Infants and small children are quite loud, particularly if they are distressed. Since a ubiquitous state of ‘sound-off’ is critical to remaining undetected, the time may come to make a questionable judgement about how best to subdue and silence an infant or child.
In such a situation the course of action taken will be risky since the child must silenced and restrained as quickly as possible. There is no time to wait for the child to be comforted and the child cannot be allowed to escalate.
A panicked attempt to cover the mouth of the child may result in accidental smothering and may not even provide the immediate silence required. A screaming child may also raise the panic level amongst those around it when they themselves are struggling to remain silent and calm.
If the child is of sufficient age to be shocked into silence (such as yelling, or face-slapping) this may be preferable to the emergency administration of fast-acting sedation. While it will be important to explain to the child why they were slapped after the emergency situation has passed, it may be the safest and most reversible action available. The shock attempt at intervention may have an escalating effect versus a silencing one and there is always the risk that they will incur physical injury from any physical contact such as a slap.
Removing children from situations as soon as possible is ideal while also providing as much comfort and security as can be provided. Covering the eyes and ears of the child while removing themselves and the adult in charge of them to a quiet and secure place (such as the closet or another room) may allow the supervisor to keep them calm while also protecting them from escalating in accordance with the heightened arousal in the room amongst the adults.
Leaving the child alone or with other children/unstable adults is not recommended.

- What if an Adult becomes hysterical and/or dangerous?
It would seem likely enough that at least one adult in the group will succumb to turbulent panic and emotions that planning for it should be as pertinent as planning to seal one’s house, or obtaining weapons and food.
A panicked or violent individual is very prone to further escalation and should be subdued and calmed as quickly and safely as possible. The restraint of a child is relatively safe to those intervening versus those attempting to restrain an adult, particularly if the adult is armed.
Any individuals not required to assist in the restraint of the aroused individual should leave the room with a temporary leader of that group clearly designated so that they may maintain order amongst those being evacuated to a different area while the unruly individual is dealt with.
Any animals present should also be removed to Kennels, closets or other containment modules outside of the situation.
Human resources should be considered in the split-second it takes to realize an intervention must occur. By this I mean that of those leaving the situation, one must be clearly capable and educated to assume leadership should everyone in the situation room perish or become severely injured. This may mean the current leader should go, or the next in line, even if they are a better fit for dealing with the current situation. The line of command, so to speak, must be preserved.

If the individual is hysterical and unable to gain control of their emotions
Remove the individual and attempt to comfort and talk them down. If they’re decibel level is a concern, encouraging them to cry and scream into a pillow may suffice. The administration of fast-acting, mild sedative or anxiolytic such as a single milligram of Lorzepam(Ativan) or Alprazolam (Xanax) may work be it administered orally or through trans-dermal injection.
If the individual is a danger to themselves or others but is not armed
Have other individuals unneeded to restrain the unruly individual leave the room. Physically subduing and immobilizing the individual will permit the placement of restraints and allow the administration of a sedative if the person is unresponsive to forced submission. Care must taken not to injure the unruly individual and not to cut off the circulation to any limbs that are restrained. Care should also be taken to reassure the individual that no one is trying to hurt them and that everything will be OK.
If the individual is a danger to themselves or others and is armed
Walking away from the situation may be the best course of action if it is possible. Attempting to subdue an armed individual will most likely result in at least one injury and very likely a death. One’s best judgement will have to suffice in such a situation.

- How to contain a loud or excited pet?
Sedation or the use of an electronic shock collar may be required.

Phase III.
If we have successfully managed to survive the major panic, the seasons, and the home infestation, then preparing to leave the home would seem the most likely source of action. Remaining near cities and once-populated areas is not ideal in my opinion. We are not counting on rescue of any kind, nor do we plan to seek it. At some point the unattended factories, power-plants, nuclear reactors, sewage systems, etc may become compromised. We will choose to assume that a disaster arising from neglect and/or disrepair will occur or that a radical plan of containment such as a hydrogen air bomb or a nuke may be on its way. Since we are also going to assume that civilization is lost we will move north into sparsely populated wilderness areas. For us, we will move towards the south of the North West Territories of Canada west of Hudson’s Bay.

After a long period of isolation we will have to make an attempt to resupply and procure both weapons and gear that will sustain us on the trip north. If the SUV and ATV are still viable and the back roads appear clear we may opt to take them, at least until we were sufficiently outside of the city and surrounding county limits.

Depending on the season, we may need to either risk staying longer, or only move towards a place half-way between our current location and destination and set up again there. We will need at least a few months of warm weather to establish a new location and stock up for the next winter coming, we will also need a reasonable amount of time to permit for a learning curve since we will need to learn new skills and must be prepared for obstacles such as proving to be ineffective hunters, finding an entire forest burn down, or failing at our first attempt at cultivation.

On the way up we will want to loot the following places:
- A library: We’ll need to learn new things such as agriculture, herbal medicine, landscaping, carpentry, chemistry, orienteering, etc.
- Several pharmacies: having medicine on hand will be Crucial to survival in the long run, but especially in the beginning as we were be exposed to things we are unfamiliar with and we are very likely to get ourselves injured and/or sick by making mistakes.
- Fuel Outlet: if we can find one, we will have many uses for fuel
- Hardware Store
- Automotive Shop
- Clothing Shop
- Farm: Maybe animals will be left
- Police Stations/Abandoned Military Outposts/Prisons: If people that carried guns were once there, their bodies and their side-arms may still be.

Securing an ‘outpost’ further south from our destination/new home would serve to allow us to hike into and out of the wilderness so that we can portage supplies and gear up from civilization(if it’s still there).

Medical Service (No-Phase)
I know that the average individual is most likely to take the survival ideology of 'Every Man for Himself'. If there was ever a creed a could point to when explaining to my children why so many things in the world were sickening, stupid or just plain shameful, it's the ol' Dog-Eat-Dog mentality. If that were really how the natural world worked, then there would be no more doggies to chew on and one fat, lonely and oh yes, now hungry again, slob of Dog.

Be it fiction or reality, people annoy, disgust, frustrate. and hurt me. My day-to-day philosophy has long-since been that no one chooses to be alive, someone else (parents) decide to force a life into being. When I look at human beings, this is how I default them all to zero. This is essential in my vocational station. Should a world-wide catastrophe occur that renders a survival situation occur I would be remiss to predict that I would abandon my principles, my cultivated nature, in favour of irresponsibility, selfishness and unwillingness to be a creative problem solver with enough balls to gamble their own life in an effort to uphold what I believe to be ethical and consequentially worth living for.

The Reality of Emergency Medicine (Read: Not First-Aid) in a Crisis Situation on the Field
- Aseptic Technique may be minimal at best
Whether you run out of supplies or you run out of time, you may have to gamble the likelihood of an infection (either to yourself or the casualty) with the likelihood of immediate death. You don't always have the resources to drape, swab and seal and you may have to decide between 'doing it right' or doing it at all.
- Triage must be performed with extreme prejudice
Emergency Triage is not as simple as sorting at out who gets to go first. With minimal supplies, time and/or man-power you have to operate within a tightly-confined range along a spectrum of assessed injuries. It becomes not about what order casualties can be seen in, but who will be seen at all. The cut-off point for who will have to take their chances on their own, and the point at which circumstances exclude a casualty from effort, move more closely together on a transverse plane.

On Their Own <-------Immediate and Salvageable ------> Leave for Dead
- Your going to kill someone
Whether your efforts to intervene kill them, or your judgement is simply to move-on, you'll be responsible for your actions and your decisions.
- Your options are extremely limited
There is only so much you can do without technology. Many casualties require artificial airways, blood and fluid replacement, oxygen therapy, immobilization and the pharmaceutical agents required in the processes of administering these interventions. There is a reason paramedical units travel in ambulances, and a reason why those ambulances are stocked with drugs, tubing, saline, monitors, backboards and other critical supplies and equipment. If you came upon a casualty situation, your triage decisions would have to made on the basis of what you can really do with what you have, whether or not stabilizing a patient is worth it if their further survival after stabilization is dependant upon delivery to a medical facility and what you can afford to waste if your efforts are not successful.
If a casualty requires surgery, life-support, or specialized equipment, what can you really do with what you have on your person, or with what is immediately available. Further more if you don't even know what you would need, you won't be able to make a decision that approaches accuracy.
- Training alone won't be enough
Even if you have a nurse, medic or a physician in your party, they won't be able to do much more than a well-educated first-responder without basic clinical tools, emergency drugs, and a plethora of medical technology and supplies. Even something as simple as an artificial airway can't be done without the plastic airway tube itself and the means with which to pump air through it. Even if you have that, you still need a stethoscope or placement bulb to ensure you didn't end up in the esophagus versus the trachea. Most professionals are accustomed to performing such procedures with lighted laryngeoscopes, a stylet and an assistant. If the patient isn't unconscious, performing an airway insertion would require a sedative, and in some cases, other drugs.
Placement of a manual airway alone would still entail asking yourself whether you really think its safe to stick your fingers into a patients mouth and risk having them bitten off at the hilt.
Medicine in the field is complicated and if there is no hope of pick-up, it gets even worse.